Radiation Oncology Policy Update – April 2011

Radiation Oncology Policy Update – April 2011

By: Libery Partners Group

Congressional Briefing on the Value of Radiation Oncology

On March 31, Members of Congress and Congressional staff attended a briefing on Capitol Hill to discuss the value of radiation oncology. Twelve organizations*, along with Congresswomen Sue Myrick (R-NC) and Lois Capps (D-CA) participated in this event. The briefing was held to educate lawmakers and their staff about the latest in radiation therapy technologies and techniques, improvements in patient care and the community’s focus on patient safety in radiation therapy delivery. A cancer survivor, Representative Myrick stated that, “[Radiation therapy] allowed me to continue my normal routine while undergoing treatment. I credit my speedy recovery in large part to radiation therapy, and the caring expertise of my doctors.”

Participating organizations in the event support the passage of the Consistency, Accuracy, Responsibility and Excellence (CARE) in Medical Imaging and Radiation Therapy Act. This legislation, which will soon be introduced by Representative Ed Whitfield (R-KY), helps to ensure patient safety through the establishment of national educational and certification standards for health care professionals and radiologic personnel who administer radiation therapy treatments.

* Radiation Therapy Alliance, American Society for Therapeutic Radiology and Oncology, The American Association of Physicists Medicine, American Society of Radiologic Technologists, US Oncology, Siemens, Varian, Elekta, Advanced Medical Technology Association, Community Oncology Alliance, American College of Radiation Therapist, and Medical Imaging and Technology Alliance.

MedPAC Releases March 2011 Report

On March 15 MedPAC released its March 2011 Report to Congress. In the report, MedPAC estimates that radiation therapy volume per beneficiary grew at an average annual rate of 7.1 percent between 2004 and 2008, but only 1.9 percent between 2008 and 2009. This compares to volume per beneficiary growth for all physician services under Medicare of 4.1 percent between 2004 and 2008 and 3.3 percent between 2008 and 2009. MedPAC also recommends that the Congress should update payments for physician fee schedule services in 2012 by 1 percent.

Co-Chairs of President’s Fiscal Commission Appear on Hill

Alan Simpson and Erskine Bowles, co-chairs of the President’s Fiscal Commission, appeared in front of the Senate Budget Committee on March 8. Both gentlemen testified on The National Commission on Fiscal Responsibility and Reform report released in December 2010 by the Fiscal Commission. The commission stated that with baby boomers retiring and health care costs continuing to rise, by sometime in the next decade Federal revenues will only finance interest payments, Medicare, Medicaid, and Social Security. Consequently, the U.S. will have to use borrowed money to fund everything from national defense to education. The commission report proposed over a dozen specific policies to achieve savings in Medicare and Medicaid. In addition, the commission recommended to reform and fully finance a fix to Medicare’s “sustainable growth rate” formula for physician payments.

FY 2012 Budget for HHS

On March 3 the Secretary of HHS, Kathleen Sebelius, appeared as a witness before the House Energy and Commerce Committee to answer questions regarding HHS’ FY 2012 proposed budget. In her testimony, Secretary Sebelius reiterated the Administration’s commitment to permanently reform Medicare’s SGR formula and noted that the President’s Budget contains specific reforms to offset the cost of a two-year “doc fix.”

Medicare Fraud under the Microscope

GAO released a report on March 2 requested by a House subcommittee investigating Medicaid and Medicare fraud, which estimates that the federal government is losing $48 billion a year on improper payments. In addition, on March 2 the Senate Finance Committee held a hearing on Preventing Health Care Fraud and invited the Deputy Administrator and Director of CMS’ Program Integrity, Dr. Peter Budetti, as one of the witnesses. Dr. Budetti suggested that the ACA has allowed CMS to implement new authorities to fight fraud, waste, and abuse. However, in order to better monitor the progress of CMS’ efforts in fighting Medicaid and Medicare fraud Chairman Max Baucus (D-MT) requested that Dr. Budetti provide the Committee with quarterly reports that include data, benchmarks and dates, on how much fraud has been stopped and how many taxpayer dollars have been saved.

Legislation Introduced to Fight Fraud in Medicare and Medicaid

Senator Chuck Grassley (R-IA) introduced the Strengthening Program Integrity and Accountability in Health Care Act of 2011 on March 2. The legislation includes provisions that would:

  • Limit tax dollars lost to fraud by giving the government more time to pay Medicare providers when fraud, waste and abuse are suspected;
  • Enhance coordination among federal agencies responsible for fighting medical identity theft;
  • Stop payments for illegal, unapproved drugs;
  • Expand the range of individuals subject to penalties;
  • Require Medicare claims and payment data to be available to the public by provider name for the first time.

Health Insurance Exchanges and Ongoing State Implementation

On March 17, the Senate HELP Committee held a hearing on Health Insurance Exchanges and Ongoing State Implementation of the Patient Protection and Affordable Care Act. Deputy Administrator and Director for CCIIO, Steve Larsen, testified. Director Larsen confirmed that the Secretary of HHS would define elements of the “essential health benefits” package under the ACA, but noted that the IOM will provide guidance along with a survey that is being conducted by the Department of Labor. Director Larsen also stated that is was the Department’s goal to issue the proposed rule on health insurance exchanges sometime this spring.

HHS Released the National Strategy for Quality Improvement in Health Care

CMS’ Innovation Center Website Relaunched

The senior leadership team of the Innovation Center held a call on March 21 to discuss the launch of their website. The Innovation Center is an arm of CMS created under the ACA to “test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care” for those who get Medicare, Medicaid or CHIP benefits. Acting Director of the Center, Dr. Richard Gilfillan, said that the mission of CMS under HHS Secretary Kathleen Sebelius and Director Donald Berwick is to create better health care, drive better health, and lower the total cost of care. For more information on the Center please click here.

Colorectal Cancer Prevention Measures and Treatment Legislation Introduced

Representative Kay Granger (TX) introduced the Colorectal Cancer Prevention, Early Detection, and Treatment Act (H.R. 912) on March 3. This legislation would increase access to colorectal cancer screenings by authorizing grant funds to establish a national Colorectal Cancer screening and treatment program. The grants would target screening and treatment for low-income, uninsured and underinsured individuals that would otherwise not have access to such care.

CMS Special Open Door Forum: Accreditation of Advanced Diagnostic Imaging Suppliers

On March 22 CMS held a second Special Open Door Forum which was titled Furnishing and Billing for the Technical Component of Advanced Diagnostic Imaging. The call reviewed the following:

  • The law governing the requirement for accreditation of advanced diagnostic imaging;
  • Who needs to be accredited in order to bill Medicare for the technical component starting January 1, 2012;
  • The steps to follow and timeline for the accreditation process;
  • Why it is necessary to begin preparations now in order to prevent disruption in payment.

The presentation for this call can be found here.

IOM/ASCO Workshop on Clinical Trials

On March 21, 2011, the Institute of Medicine (IOM) National Cancer Policy Forum and the American Society of Clinical Oncology held a Workshop to discuss implementation of recommendations outlined in the IOM Report, “A National Cancer Clinical Trials System for the 21st Century: Reinvigorating the Cooperative Group Program.” Featured speakers included Cooperative Group leadership and representatives of the National Cancer Institute (NCI), US Food and Drug Administration (FDA), Pharmaceutical companies, payors and patient advocates.

The meeting focused on implementation four major principles contained in the IOM report:

Improve speed & efficiency of cancer clinical trial development and activation

Incorporate innovative science and cancer clinical trial design

Improve prioritization, support, and completion of cancer clinical trials

Incentivize participation of patients and physicians

Major initiatives currently being implemented are:

  • Consolidation, in consultation with Cooperative Group Chairs, of the current Cooperative Group structure into a maximum of 4 Adult Cooperative Groups with continued funding of one Pediatric Group
  • Prioritization of Phase II and III cancer clinical trials
  • New organizational structure for NCI-sponsored clinical trials network, and interagency agreement with FDA for priority review of Phase III cancer clinical trials
  • Development and assessment of innovative designs for clinical trials that evaluate cancer therapeutics and biomarkers
  • Potential of a centralized Institutional Review Board
  • Reimbursement by NCI and payors for clinical trial investigators
  • Submission of annotated biospecimens to standardized central biorepositories when samples are collected from patients in the course of Group trials
  • Insurance coverage of routine patient costs associated with clinical trial participation
  • Efforts to accrue more minority patient populations into cancer clinical trials

Additional information about the IOM/ASCO workshop, including the presentations of speakers, may be found here.

PQRS & eRx Incentive Program National Provider Call

On March 8 CMS hosted a national provider call on the 2011 Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program. The call focused on measure reporting and participation in the 2011 PQRS and eRx programs. The presentation for this call can be found in the Downloads section if you click here.

Prior to the presentation several reminders were given regarding participation in the eRx incentive program. In November CMS announced that in 2012 eligible professionals who are not successful eRx prescribers may be subject to a payment adjustment on their Medicare Part B physician fee scheduled covered services. Starting in 2010 through 2014 the payment adjustment will increase each calendar year. In 2012 if you are not a successful eRx prescriber you are subject to a 1% payment adjustment increase. There will be a 1 ½% increase in 2013 and 2% in 2014. To earn an incentive in 2011 you have to prescribe 25 times throughout the course of the year, but 10 prescriptions have to be in the first 6 months. Earning an incentive does not necessarily exempt a physician from a payment adjustment.

Medicare Attestation Begins on April 18

Attestation for the Medicare Electronic Health Record (EHR) Incentive Program begins April 18. In order to receive the Medicare EHR incentive payment, physicians must attest through the CMS Medicare and Medicaid EHR Incentive Programs Registration and Attestation System. Providers eligible for both programs must choose one incentive program in which to participate. The user guide for the Medicare and Medicaid EHR Incentive Program Registration and Attestation System can be found if you click here.

Determination of Essential Health Benefits

The ACA charged the Secretary of HHS to define the essential health benefits offered to consumers beginning in 2014. As a source the Secretary has asked the IOM to make recommendations on the criteria and methods used for determining and updating the essential health benefits package. On March 2-3 the IOM Committee on the Determination of Essential Health Benefits held its second of four meetings. Panelist Dr. Samual Nussbaum, Executive Vice President for Clinical Policy and Chief Medical Officer of Wellpoint, Inc. suggested that cost drivers in health care be taken into account when considering the package. He continued by saying that the “pillars” of the package should include: affordability, value, and flexibility of benefits. Dr. Nussbaum reinforced this statement by noting Wellpoint’s efforts in value-based benefit design had lead to lower costs in diabetes care, pharmacy benefits, and prostate cancer treatment.

Andrew L. Woods

Liberty Partners Group